VISIT STATE HEALTH COMPARE
Publication
Comparing Federal Government Surveys That Count the Uninsured: 2018
This brief provides an annual update to comparisons of uninsurance estimates from four federal surveys1:
- The American Community Survey (ACS)
- The Current Population Survey (CPS)
- The Medical Expenditure Panel Survey - Household Component (MEPS-HC)
- The National Health Interview Survey (NHIS)
In this brief, we present current and historical national estimates of uininsurance along with the most recent available state-level estimates from these surveys. We also discuss the main reasons for variation in the estimates across the different surveys.
1 Another federal survey that provides estimates of the uninsured is the Behavioral Risk Factor Surveillance System (BRFSS), which provides uninsurance estimates for the adult population 18 years and over nationally and among states. Details about the BRFSS are included in Appendix A of the brief, and estimates from the BRFSS are provided in Appendix B.
Publication
New Coverage Data from the ACS & CPS: An Annual Conversation with the U.S. Census Bureau - September 18th Webinar
Date: September 18, 2018
Time: 11:00 a.m. - 12:00 p.m. Central
Watch a recording of the event below, or download a PDF of the slides and the event transcript.
This webinar provided an overview of the 2017 health insurance coverage estimates from two key, large-scale federal data sources: the American Community Survey (ACS) and the Current Population Survey (CPS).
- The new 2017 national and state coverage estimates
- When to use which estimates from which survey
- How to access the estimates via Census reports and American FactFinder
- How to access state-level estimates from the ACS using SHADAC tables
Event Resources
SHADAC's State Health Compare (Data Dissemination Site)
2017 ACS Tables: State and County Uninsured Rates, with Comparison Year 2016 (SHADAC Resource)
U.S. Census Bureau: Health Insurance (Data Dissemination Site)
U.S. Census Bureau Health Insurance (PDF Report)
List of updated American FactFinder tables (2017)
U.S. Census Bureau Statistical Testing Tool
U.S. Census Bureau Census Data Site Preview (Beta-stage Data Site)
U.S. Census Bureau 2016/2017 Census Test (Report)
Most Uninsured Were Working-Age Adults (Census Blog)
2017 ACS: More States Saw Declines in Private and Public Coverage, Fewer Saw Increases, than in 2016 (SHADAC Blog)
2017 ACS: Uninsured Rate Increased Nationally and in 14 States (SHADAC Blog with Infographic)
Publication
2017 ACS Tables: State & County Uninsured Rates, with Comparison Year 2016
The map on this page linkes to tables containing state and county uninsurance estimates for 2017. These estimates come from the 2017 American Community Survey (ACS) via the U.S. Census Bureau's American FactFinder (AFF) tool and were released on September 13, 2018.
Click on a state to see state and county uninsurance rates by characteristics (for example, age, race/ethnicity, and poverty level) for 2017 and comparison year 2016. Due to sample size constraints, single-year ACS estimates are available at the county level only for counties with a population greater than 65,000.
Click here to view uninsurance estimates for the United States.
Click here to view uninsurance estimates for Puerto Rico and its municipios.
Note: These tables present uninsured rates, which indicate the share of the population that is uninsured. For example, a 10 percent uninsured rate for adult women indicates that 10 percent of all adult women are uninsured.
Additional Estimates (50-State Comparisons)
Maps & Tables of Private, Public, & Uninsured Change from 2016 to 2017
- Private Coverage Rates by State, Change from 2016 to 2017, for All People
- Public Coverage Rates by State, Change from 2016 to 2017, for All People
- Uninsurance Rates by State, Change from 2016 to 2017, for All People
About the ACS
The ACS is a household survey that began in 2005 and produces annually updated data on a variety of population characteristics, including health insurance coverage. In total, the ACS surveys approximately three million US households each year. An important feature of the ACS is that it includes a large enough sample for state‐level and sub‐state estimates.
The ACS began asking survey respondents about health insurance coverage during the 2008 calendar year. Specifically, the survey asks respondents about current coverage for each person in the respondent’s household. A person is categorized as “insured” if he or she has coverage at the point in time at which the survey is administered.
Why Aren’t Estimates Provided for All Counties?
Due to sample size constraints, single-year ACS estimates are available at the county level only for counties with a population greater than 65,000.
How Are these Estimates Different from the Estimates that SHADAC Publishes Using Census Bureau Micro-Data Files?
Two definitions used by the Census Bureau to generate the tabulations above differ from those that SHADAC uses to generate tabulations for State Health Compare. The definitional differences are as follows:
Family
- The Census Bureau defines a family as all related people in a household.
- SHADAC defines a family using a measure called the “Health Insurance Unit” (HIU), which includes all individuals who would likely be considered a family unit in determining eligibility for either private or public coverage.
Family Income
- The Census Bureau determines family income as a percentage of the Federal Poverty Level (FPL), which is a definition of poverty used primarily for statistical purposes. For example, FPL is used to estimate the number of Americans living in poverty each year.
- SHADAC determines family income as a percentage of the U.S. Department of Health and Human Services’ Federal Poverty Guidelines (FPG), which is a measure used for administrative purposes. For example, FPG is used to determine eligibility for federal programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
- To learn more about the difference between FPL and FPG click here.
Blog & News
Now Available: SHADAC Presentations from the 2018 AcademyHealth Annual Research Meeting
July 19, 2018:SHADAC presentation materials from the 2018 AcademyHealth Annual Research Meeting (ARM) are now available. Click on the presentation titles below to view and download the materials.
- “The Intersection of Structural Risk Factors and Insurance-Based Discrimination on Healthcare Access Inequities”
Presenter: Kathleen Call
Co-Authors: Rhonda Jones-Webb, Brooke Cunningham, Giovann Alarcón, Sarah Hagge, Alisha Simon - “Who Gets It Right? Characteristics Associated with Accurate Reports of Health Insurance Coverage”
Presenter: Kathleen Call
Co-Authors: Angela Fertig, Joanne Pascale, Don Oellerich - “Minnesota LTSS Projection Model: MN-LPM”
Presenter: Giovann Alarcón
Co-Authors: Robert Hest, Lynn A. Blewett - “Modeling Financial Eligibility for Medicaid Payment of LTSS”
Presenter: Robert Hest
Co-Authors: Giovann Alarcón, Lynn A. Blewett - “Modeling State-based Reinsurance: One Option for Stabilization of the Individual Market"
Presenter: Brett Fried
Co-Authors: Lynn A. Blewett, Coleman Drake - “Advancements in Care Coordination: Findings from an Evaluation of Minnesota’s State Innovation Model Initiative”
Presenter: Carrie Au-Yeung
Co-Authors: Christina Worrall, Donna Spencer, Emily Zylla, Kelli Johnson, Lacey Hartman - “Section 1115 Medicaid Expansion Waivers: Implementation Experiences of Arkansas, Indiana, Iowa, & Michigan”
Presenter: Carrie Au-Yeung
Co-Authors: Emily Zylla, Elizabeth Lukanen, Colin Planalp
Blog & News
NHIS: Insurance Coverage Held Steady Overall in 2017, but Key Income Groups Saw Changes
June 04, 2018:The National Center for Health Statistics (NCHS) released health insurance coverage estimates for 2017 from the National Health Interview Survey (NHIS) as part of the NHIS Early Release Program. These are the first available full-year coverage estimates for 2017 from a federal survey, with estimates available for the nation and 18 states.
Insurance Coverage Remained Stable Overall in 2017
Rates of insurance coverage remained statistically unchanged between 2016 and 2017 nationwide and in the 18 states for which NCHS released estimates among most populations by age, sex, race/ethnicity, Marketplace Type, Medicaid-expansion Status, and region (Figure 1). There were, however, significant changes in rates of insurance coverage among non-elderly adults by income level in 2017.
Health Insurance Coverage by Income
Increase in uninsurance and decrease in private coverage among those 250-400% FPL
Between 2016 and 2017, the rate of uninsurance increased from 10.1% to 12.6% among non-elderly adults (ages 18-64) with incomes between 250% and 400% of the federal poverty level (FPL). This change was statistically significant. This increase in uninsurance was coupled with a statistically significant decrease in private coverage from 78.2% in 2016 to 75.5% in 2017 among the same group (Figure 2).
Eligibility for premium tax credits insulate individuals in this income range from premium increases, so the observed increase in uninsurance and decrease in private coverage among this group suggests that some may have left the individual market in response to other factors such as uncertainty surrounding the status of the ACA, available premium subsidies, and the individual coverage mandate.
This hypothesis is supported by the lack of any statistically significant changes in private coverage among non-elderly adults with incomes too high to be eligible for premium tax credits (>400% FPL) and among non-elderly adults with incomes that make them eligible for cost-sharing subsidies and more generous premium tax credits (100%-250% FPL). Additionally, there was a small but statistically significant decrease in private health insurance coverage purchased through the ACA Health Insurance Marketplaces among non-elderly adults with incomes 200% FPL or higher (4.3% in 2016 to 3.8% in 2017).
Increase in private coverage, decrease in public coverage for those below 100% FPL
Between 2016 and 2017, the rate of private coverage increased from 21.6% to 26.5% among non-elderly adults with incomes below 100% FPL. This change was statistically significant. This increase in private coverage was coupled with a statistically significant decrease in public coverage from 53.7% in 2016 to 50.2% in 2017 (Figure 3). There was no statistically significant change in the uninsurance rate or in rates of private health insurance coverage purchased through the ACA Health Insurance Marketplaces among this group between 2016 and 2017. This evidence points to an increase in private coverage from sources other than the ACA Marketplaces and a corresponding decrease in public coverage (i.e., Medicaid).
We will continue to monitor changes in insurance coveraged among these and other income groups as more detailed 2017 data becomes available later this year.
About the Numbers
The above estimates provide a point-in-time measure of uninsurance, indicating the percent of persons without coverage at the time of the interview.
The sample size of the NHIS fell from 97,459 in 2016 to 78,074 in 2017, a decrease of 19.9%. This change is important because smaller sample sizes decrease the precision of estimate and hamper the ability to make state-level estimates, to make estimates for small or minority populations, and to statistically detect changes over time.
For more information about the early 2017 NHIS health insurance coverage estimates, read the National Center for Health Statistics brief.
Citation
Cohen, RA, Zammitti, EP, & Martinez, ME. May 22, 2018. “Health Insurance Coverage: Early Release Estimates from the National Health Interview Survey, 2017.” National Center for Health Statistics: National Health Interview Survey Early Release Program. Available at https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201805.pdf
